Monday, April 14, 2014

Well, it get's worse.A fellow agent in the midwest has two clients that are turning 65 and would like to get OUT of Obamacare and INTO Medicare.But they can't.Both bought through the exchange.In his own words . . .

First case tried to log in (to healthcare.guv) and do life event and change the needed information on the application. It removes any/all subsidy for the spouse who is not Medicare. Agent in my office could have made this easier by putting the account in husband's name, not the wife.

The second, my 10am this morning, was a DIY case, no log in, will have to call the exchange this morning. Same, account should have been put in his name and not hers since she was only a few months off Medicare.

Yes my friends, it seems it is easier to enter the U.S. illegally than to get rid of your Obamacare plan.

Tonight marks the first evening of Passover, and the first of the two traditional meals called "seders" ("seder" means "order"). It's a ritual and a meal, and commemorates the end of the Israelites' 400 year stint as slaves to the Egyptians.

I use the term "Israelites" because there is a significant school of thought which holds that we didn't really become "Jews" until the Covenant at Sinai.

The ritual itself, at least as practiced today, dates back about 1000 years or so, so it's actually a rather recent addition to our history. Still, it's by far my favorite "Chag" (holiday). This year, as most, we will host seders both nights, with a great (and different) mix of folks at both.

Chag Pesach Sameyach!

(PS Click here for a detailed and interesting deconstruction of so-called "Christian Seders")

"Despite all the government rhetoric, despite the Francis, Keogh and Cavendish reports, the spectre of another Mid Staffs still looms large over theNHS. Progress on safe staffing levels has been glacial and that means poorer care and patients still at risk.

"It's clear that despite nurses working through breaks and beyond their hours, they simply do not have enough time to give patients the care and attention they need. That is distressing for patients and for the staff trying to care for them.

Government rhetoric.

Has a familiar ring . . .

"The government needs to face up to the damage it is inflicting on patients and staff, by not introducing legally enforceable nurse-to-patient ratios, and take urgent action."

So a problem created by the government needs a government fix?

Egad. It's worse than I thought. Does Britain have low information voters too?

Sunday, April 13, 2014

The creators of Obamacare envisioned a massive overhaul of the U.S. health care system that

would insure millions. Noble idea, long on grand intentions, short on effectiveness.

Liz Linton feels stuck in health insurance limbo. She has policies protecting herself and her husband, but no coverage for her two children."They pretty much told me I'm out of luck," said Linton. "If something happens, you're responsible for the bill."On December 16th, the Goreville mother met with an enrollment counselor. She discovered her children qualified for the All Kids state program. "I signed up," said Linton. "She told me it would probably be a month or two before we hear anything."However, two months have now stretched into more than four. Her youngest child also came down with a case of bronchitis.

Friday, April 11, 2014

Dennis would specifically like to see posts about residential mortgages, force-placed insurance, the participants in the mortgage process, the participants in securitization of mortgages.You'll need to provide:

■ Your post's url and title■ Your blog's url and name■ Your name and email■ A (brief) summary of the post

PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like). And please only submit if you are willing to link back to the carnival if your submission is accepted.

Let’s take a look at these doctors based on CMS own data: “a small sliver of the more than 825,000 individual physicians in Medicare's claims data base — just 344 physicians — took in top dollar, at least $3 million apiece for a total of nearly $1.5 billion.”

So if only 344 physicians earn the top dollar out of 825,000 physicians how much did the other 824,656 physicians make?

“The median payment — the point at which half the amounts are higher and half are lower — was $30,265.”

While we don’t know what the other physicians made, we do know that the median amount paid to all physicians was $30,265. Medicare makes up about 30% of the payer mix for an average physician’s office. So what we can concur from this information, from the most transparent administration in the history of America, is that 30% of a physician’s revenue was approximately $30,000. Does this information in any way change how you choose a doctor?

“Employers, insurers, consumer groups and media organizations pressed for release. Together with other sources of information, they argued that the data could help guide patients to doctors who provide quality, cost-effective care”

An argument for releasing this information is so consumers can be better educated on choosing their doctors based on how much Medicare pays the doctor for the service provided. One piece of insight already data mined from all this information is that Medicare pays for cataracts and cancer treatment.

“In the $3 million-plus club, 151 ophthalmologists — eye specialists — accounted for nearly $658 million in Medicare payments, leading other disciplines. Cancer doctors rounded out the top four specialty groups, accounting for a combined total of more than $477 million in payments.”

So using the rationale that this data will allow consumers better decision-making on choosing physicians, are we shocked that Medicare - insurance for the elderly - pays out a significant amount of money for cataracts and cancer treatment, both illnesses of the elderly?

Having been both a provider and an administrator in the medical field for close to 15 years, what this information tells me is that doctors are for the most part underpaid by Medicare. If the median amount is $30,000 that any one physician makes in treating Medicare patients and the Medicare population is rising, then it is obvious that the reimbursement rates are lowering. This is exactly what is been happening since the year 2003 with a Medicare fee schedule that, while it does not cut, it does not give raises. As a medical administrator, all this information has done is prove to me that Medicare is not adequately paying for the work performed by physicians.

In the dark ages prior to ACA an individual could buy an insurance policy any time they like. No matter the month if you wanted insurance you could buy it. If you waited till you were sick you might pay more. A very small group of people were denied or had to enroll in high risk pools. But 85 to 90% of the population could buy any time they liked.

Now that ACA is in place and open enrollment closed unless you have a qualifying event you can't buy insurance no matter what, and that applies to 100% of the population.

Just a reminder that, two weeks after the (ostensible) end of Open Enrollment, Ms Shecantbesrious still can't (or won't) say how many of the "billions and billions" who signed up were simply victims of the ObamaTax "You Can Keep Your Plan" Hoax.

A key provision in Obamacare requires doctors to spend at least 80% of their gross revenue on patient care, leaving them 20% for overhead.It seems that the onerous MLR rules for carriers also apply to physician practices.

Some doctors say they need to charge the extra fees because of the rising costs of running a practice. Some even cite the Affordable Care Act, also known as Obamacare, as adding to their costs.

“The Affordable Care Act has another provision that puts a limit on how much your premium can be spent on patient care, rather than administration and profit. So, again, having an outside fee that is for administration is in violation in the spirit of the law, which is to try to limit the amount of money that’s spent on administration profit, and really target those dollars towards patient care,” Wright said.

As major an issue as Saundra Fluke and free birth control was, those actually buying the plans don't seem to need it. By the time you're signed up for ObamaCare you have already been screwed so they don't need it?

"The expansion of health insurance accomplished under the Affordable Care Act may alter costs for several major types of liability insurance ... Automobile, workers’ compensation, and general business liability insurance costs may fall under the Affordable Care Act, while costs for medical malpractice coverage could be higher"

Just because you've done the training, passed the test and obtained your Concealed Carry permit doesn't mean that you're covered if you ever need to use it. In fact, you should probably assume that if you injure or kill someone, even if you're eventually exonerated by law enforcement, your worries may be far from over.

Lots of attention was given, in the aftermath of the Newtown tragedy, to liability issues when a gun is used in a crime. And almost exactly a year ago, we discussed the proposal put forth by retired business owner Tom Harvey to compensate victims of illegal gun violence.

But what about the legal use of a weapon in self-defense? The rate of concealed carry permits has risen dramatically the past few years, and most folks have either home or renter's insurance. What part might these policies play if one were to injure or kill someone else in self-defense?

[ed: we'll deal here only with homeowners' policies - as always, we urgently suggest that you consult with your own agent about your specific policy]

The typical homeowner's policy follows a fairly predictable pattern: "we give you coverage, we take it away, then we give some of it back to you." The relevant policy section in this instance is "Coverage E - Personal Liability." This coverage protects one's assets if one is sued for injuring someone else. The policy extends coverage for this type of claim, but then excludes those claims that arise due to intentional acts. In this case, it's pretty clear that you intended to shoot your attacker, so it seems as if you're on your own.

Right?

Not so fast there, pardner:

Mr Kinney points out that newer policies will generally have an "exception to an exclusion;" that is, a policy clause that gives us back some coverage. In this case, it is for intentional acts that result from the use of "reasonable force." Unfortunately, as Mr Kinney also points out, the policy doesn't actually define "reasonable force."

So is there coverage, or not?

In Ohio, the law says that "a person is presumed to have acted in self-defense ... when using defensive force that is intended pot likely to cause death or great bodily harm ... if the person against whom the defensive force is used in in the process of unlawfully ... entering ... the residence or vehicle occupied by the person using defensive force"

[ed: contra Mr Kinney's characterization, this is an expression of "the Castle Doctrine," not "Stand Your Ground"]

Let's take a real-life example: George Zimmerman was (famously) found 'Not Guilty' of murder. But what if Trayvon Martin's parents sued him in civil court? Would his homeowner's policy have picked up that tab? Unfortunately, the answer is "it depends:" just because a jury said it was justified doesn't necessarily mean that your insurer will pick up the tab from a civil verdict, or even cover your defense costs (which can be quite expensive). That's determined by the policy wording, and it's possible, bordering on likely, that your policy does not, in fact, afford this coverage.

So what to do.

Mr Kinney offers some suggestions for "stand alone" policies that will (purportedly) offer legal and liability coverage. It's a good idea to check with your own carrier to see if such coverage is available, and to stay as up to date as possible on the changing law (I heartily recommend Andrew Branca's "The Law of Self Defense" which covers both federal and state laws and issues).

The bottom line? Don't assume that, just because you've dotted all the i's and crossed all the t's in order to get your concealed carry permit, that your insurance policy is going to cover you. You have a lot to lose.

Sunday, April 6, 2014

A little over four years ago, we pointed out how important it is to periodically review one's life insurance beneficiary designations. Today, the Wall Street Journal has a similar warning for folks with 401(k) or similar retirement plans:

They cite the case of a recently deceased executive who had the bulk of his wealth tied up in his 401(k), but failed to coordinate the beneficiaries with his will. The result was that his wife (widow) of two months stands to gain a great deal, while his kids are left holding the (empty) bag. As the article points out, one's will does not control one's retirement funds' ways.

Really doc? Medicare pays you $18 for an office visit? Maybe I should tip the receptionist on the way out.

The data to be released, which officials described as nearing 10 million lines of information, will show the number and type of health services each professional delivered through Medicare Part B in 2012 and how much the program paid for them.

I wonder if this will be printed in book form and mailed out to anyone who asks?

All told, HHS officials said the data covers 6,000 different types of services and procedures that cost Medicare a total of $77 billion.

And what purpose will this serve?I wonder how many people actually read their EOB?

Hard to believe, but apparently some people never read InsureBlog. Probably some of the same folks that thought you could wait until you are sick to buy insurance.

"I have people that can buy insurance, but the companies shut them down. They won't take the applications," insurance broker Steve Bobiak of Frackville, Pa., said. "We're a free country. You should be able to buy anything anytime you want."

Yahoo NewsSteve, have you been under a rock for the last 6 months? Have you been spending too much time with Pelosi?As for freedom, that was given up in 2008 when there were people who voted for free stuff over hard work and initiative.

Bobiak, whose NICA Benefits company helps people buy insurance in New Jersey, Ohio and Pennsylvania, said he learned only a couple of weeks ago that insurers were cutting off new policies.

You must have been absent the day that was taught in the certification classes. Heck, even carriers knew this day was coming. Wonder why they never told you?Maybe they just assumed you knew it.

"It's lousy communication out there," he said. "If we don't know, my God, how do they expect other people to know? It's terrible."

A survey by the Kaiser Family Foundation in mid-March found that 6 out of 10 people without insurance weren't aware of the marketplace deadline on March 31.

Six out of 10.

That would be the low information crowd.

Wonder if anyone told Steve the widely reported claim that you could wait until you get sick to buy health insurance is false as well?

Friday, April 4, 2014

They spent how much to provide health insurance to a "net" 1 million people?

We may never know. But on the surface it seems obvious our tax dollars would have been better spent by simply giving money away to people who simply declared their health insurance was too expensive.

But really, Nancy Pelosi's statement was a historic admission (We had to pass the bill to see what was in it) that she was fighting hard for something she herself didn't understand, but she had every confidence regulators and bureaucratic interpreters would tell her in time what she'd done. This is how we make laws now.

Her comments alarmed congressional Republicans but inspired Democrats, who for the next three years would carry on like blithering idiots making believe they'd read the bill and understood its implications

It seems like burger flippers at McDonalds have a better understanding of what is expected of them than members of Congress.

The White House, on the other hand, seems to have understood what the bill would do, and lied in a way so specific it showed they knew exactly what to spin and how. "If you like your health-care plan, you can keep your health-care plan, period." "If you like your doctor, you can keep your doctor, period." That of course was the president, misrepresenting the facts of his signature legislative effort. That was historic, too. If you liked your doctor, your plan, your network, your coverage, your deductible you could not keep it. Your existing policy had to pass muster with the administration, which would fight to the death to ensure that 60-year-old women have pediatric dental coverage.

Thursday, April 3, 2014

UPDATE: If Centennial State sign-ups are indicative (and there's no reason to believe that they're atypical), then The Kraut is really on to something. According to the Colorado Springs Gazette, about a quarter of a million Coloradans have enrolled through the state's Exchange.

That's the good news.

Here's the bad:

Most of these folks signed up for taxpayer funded Medicaid, not private health insurance. And of the less than 120,000 who did sign up for insurance, there's no information yet on how many are subsidized, let alone how many have actually paid for their new "coverage."

Barely a day following the end of Obamacare season comes word of a class action suit over mishandling of the enrollment procedure.

Just days after the deadline to enroll for insurance coverage through Nevada Health Link, the first class-action lawsuit has been filed on behalf of residents who say they signed up and paid their premiums – but were never given coverage.

Law firm Callister & Associates filed the lawsuit on behalf of Larry Basich, who signed up for state health insurance and paid premiums as far back as November, but then was not covered following a Jan. 3 triple bypass procedure that saw his $400,000 in medical expenses passed between the wrong insurance companies,

Attorney Matthew Callister told the Review-Journal that about 40 people had called saying they had also paid their insurance premiums but have no coverage. As of last week, the Nevada Health Link had a “pends” list totaling more than 10,500 people still without coverage.

Lea Swartley, who also has received no coverage despite paying premiums, is the co-plaintiff in the lawsuit.

“There are hundreds, if not thousands, of Nevadans who have been paying premiums for 2, 3, 4 months, not receiving any coverage whatsoever,”

Wonder if Obamacare navigators have E&O coverage?

Yeah, that's a stupid question. Just checking to see if you are paying attention.

Monday, March 31, 2014

Today is (currently) the last day of the initial Open Enrollment season. Ms Shecantbeserious has indicated that, if you've tried to sign up and met with no success, the actual final day is April 15th [ed: irony - how does it work?]. I have several clients in this boat right now, and am waiting with bated breath as to how it will play out.

Golden State readers are in a very different boat. Co-blogger Bill reminds us that:

"Under the latest deadline changes, an application has to be started on CoveredCA by MARCH 31. You have until APRIL 15 to complete it. Outside of a qualifying event, if you miss the March 31 date, you're out until next year. On the Federal Exchange, they allow you to check a box that says that you tried to enroll and couldn't and are then allowed until April 15 to start a new application. That's not the case in California!"

Best get crackin'!

UPDATED: Heh (from Bill H):

The latest (slightly edited) press release from CoveredCA:

"Record-setting numbers of people trying to sign up for Covered California™ health insurance plans overwhelmed the system on the final day of open enrollment. Because of the staggering demands on the system, Covered California announced the following policy this afternoon:

• Consumers who were unable to create an online account or start their online application because of technical difficulties can contact a Covered California Certified Insurance Agent to explain that they attempted to get through on March 31 and experienced difficulties. Those consumers will have until 11:59 p.m. April 15 to work with the Certified Insurance Agent to complete their application and choose a plan.

• Consumers who created an online account and completed the first page of the application by 11:59 p.m. March 31, 2014, will be able to complete their application for the open-enrollment period, either by themselves online or with the help of a Certified Insurance Agent. Consumers must complete the application and select a plan by 11:59 p.m. April 15, 2014. Those enrollees will receive coverage effective May 1, 2014."

Rumors that the entire system is running on two surplus Commodore 64 computers are unfounded. An Altair 8800 is also employed to dynamically balance the load.

While several items were approved, the excitement was due to yet another delay for the ICD-10. In 1996, the new HIPAA law mandated the acceptance of the ICD 10, and much like the poor metric system, it has been delayed and delayed in its implementation.

Why has it been delayed? Cost and complexity:

There are significant differences between ICD-9, what is used now and ICD-10, what is currently used in 25 countries, which this table demonstrates:

ICD-9

ICD-10

3-5 characters in length

3-7 characters in length

Approximately 13,000 codes

Approximately 68,000 available codes

First digit may be alpha (E or V) or numeric;

digits 2-5 are numeric

Digit 1 is alpha; digits 2 and 3 are numeric;

digits 4-7 are alpha or numeric

Limited space for adding new codes

Flexible for adding new codes

Lacks detail

Very specific

Lacks laterality

Has laterality (i.e., codes identifying right vs.

left)

What has the medical community so upset about adopting the ICD-10: moving from around 13,000 codes to 68,000 codes. Why such an increase? Because in the ICD-10 the code tells a story. Instead of a code that says “Fracture”, the new code says “Fracture, left foot, first incident, middle toe, while a passenger in a car in a car crash”. In fact, the codes are so complex, they are unintentionally funny. Here are a few real codes:

Needless to say, the medical community is doing cartwheels over a possible delay. (The first question on a CMS ICD-10 webinar I attended at the beginning of March “Is there going to be a delay?” The answer was "no"). Let’s all hope that the Curse of the Metric System continues to plague the ICD-10 or the next time you go to the doctor your code could be “Headache before sex, subsequent occurrence, would rather read “10 Shades of Gray”, or at the least take a long hot bath, sheesh…”

Thursday, March 27, 2014

The Obama administration has been helping to facilitate a series of events nationwide at

Mexican Consulate offices to enroll people in Obamacare – and a key activist says the efforts are “our responsibility” regardless of citizenship.

“Whether they’re Mexican nationals or whether they’re United States citizens or whether they’re in transition-- and if they’re there it is our responsibility within all of America to educate on the Affordable Care Act,” Enroll America Field Organizer Jose Medrano told Breitbart News on Wednesday.

The bad news is that this week's HWR host Chris Fleming missed a total of (sweet) 16 posts by that much.

The good news is that there are plenty of great posts from which to choose, from HWR founder Joe Paduda on ideology and business decisions to David Williams ground-breaking interviews of all 9 candidates for governor of Massachusetts - pretty amazing. And our favorite health care economist, Jason Shafrin, offers some surprising insight into genetic testing and adoptions.